A Case of Reversible Posterior Leukoencephalopathy Syndrome in a Patient with ABO Incompatible Kidney Transplantation

Korean Journal of Nephrology 2010;29(2):305-309.

Jong-In Kim, M.D., An-Sook Choi, M.D., Su-Jin Kim, M.D., Byoung-Hoon Ji, M.D., Joon-Seok Oh, M.D., Young-Ki Son, M.D., Yong-Hun Shin, M.D. and Joong-Kyung Kim, M.D

Division of Nephrology, Department of Internal Medicine, Bong Seng Memorial Hospital, Busan, Korea

증례 : ABO 부적합 신장 이식 후 발생한 가역적 후백질 뇌병증 증후군 1예

김종인, 최안숙, 김수진, 지병훈, 오준석, 손영기, 신용훈, 김중경

김원묵 기념 봉생병원 내과

Abstract

Reversible posterior leukoencepalopathy syndrome (RPLS) was noted by a reversible syndrome of headache, altered mental status, seizure, and visual loss associated with findings indicating predominantly posterior leukoencephalopathy on imaging studies. We report a successful treatment of RPLS after secondary ABO incompatibility kidney transplantation with blood pressure control. A 41-year-old female whose primary kidney disease was chronic glomerulonephritis had graft failure developed after living donor kidney transplantation (1st kidney transplantation). She was admitted to our hospital for 2nd ABO incompatibility kidney transplantation. She had undergone 6 times of plasmapheresis and received additional two doses of rituximab (375 mg/m2) and intravenous immunoglobulin (0.5 g/kg) before kidney transplantation. She received basiliximab induction therapy, tacrolimus, steroid and mycophenolate mofetile after transplantation. The ABO antibody titer had been low (below 1:1) and evidences of rejection were not detected. Generalized tonic clonic type seizure, eyeball deviation, facial cyanotic change and loss of consciousness occurred at post operation 7th day. Several minutes later, she recovered her consciousness without disability and neurologic deficit. She did not represent attacks any more after we controlled blood pressure without withdrawal of immunosuppressants or dose reduction.

Key Words: Reversible posterior leukoencephalopathy syndrome, Kidney transplantation